A standard weight descriptor for dose adjustment in the obese patient

Duffull, SB, Dooley, MJ, Green, B, Poole, SG and Kirkpatrick, CMJ (2004) A standard weight descriptor for dose adjustment in the obese patient. Clinical Pharmacokinetics, 43 15: 1167-1178. doi:10.2165/00003088-200443150-00007


Author Duffull, SB
Dooley, MJ
Green, B
Poole, SG
Kirkpatrick, CMJ
Title A standard weight descriptor for dose adjustment in the obese patient
Journal name Clinical Pharmacokinetics   Check publisher's open access policy
ISSN 0312-5963
Publication date 2004
Sub-type Critical review of research, literature review, critical commentary
DOI 10.2165/00003088-200443150-00007
Volume 43
Issue 15
Start page 1167
End page 1178
Total pages 12
Editor Diana Faulds
Place of publication NZ
Publisher Adis International
Collection year 2004
Language eng
Subject C1
320503 Clinical Pharmacology and Therapeutics
730199 Clinical health not specific to particular organs, diseases and conditions
Abstract Objective: To develop a standard weight descriptor that can be used for estimation of patient size for obese patients. Patients and methods: Data were available from 3849 patients: 2839 from oncology patients (index data set) and 1010 from general medical patients (validation data set). The patients had a wide range of age (16-100 years), weight (25-165kg) and body mass index (BMI) [12-52 kg/m(2)] in both data sets. From the normal-weight patients in the oncology data set, an equation for male and female patients was developed to predict their normal weight as the sum of the lean body mass and normal fat body mass. The equations were evaluated by predicting the weight of patients in the general medical data set who had a normal BMI (<25 kg/m(2)). In addition, the clinical utility of the predicted normal weight (PNWT) descriptor was assessed by (i) comparing body surface area and allometric scaling calculations based on actual weight of obese patients versus PNWT: and (ii) comparing the predictive performance of creatinine clearance using the, Cockcroft and Gault equation when using actual weight of obese patients versus PNWT to predict gentamicin clearance. Results: The PNWT equations developed from the oncology data set predicted accurately the actual weight of normal weighted (BMI,11 <25 kg/m(2)) general medical patients (R-2 = 0.968 men, R-2 = 0.946 women). Using actual weight when computing body surface area and when allometric scaling for obese patients results in significant overestimation of patient size, especially for female patients and those with BMIs >35 kg/m(2). The use of PNWT in the Cockcroft and Gault equation provided better predictions of gentamicin clearance than when using! actual weight. Conclusions: A standard weight descriptor has been developed that can be used in dosing algorithms for patients obese (13 41 >30 kg/m(2)).
Keyword Pharmacology & Pharmacy
Body-surface Area
Creatinine Clearance
Anticancer Drugs
Renal-function
Pharmacokinetics
Prediction
Gentamicin
Therapy
Q-Index Code C1
Additional Notes This document is a journal review.

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Excellence in Research Australia (ERA) - Collection
2005 Higher Education Research Data Collection
School of Pharmacy Publications
 
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Created: Wed, 15 Aug 2007, 04:01:00 EST